MEDICARE: EMMANUEL ANTONIO GARCIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	053357	NY

General Provider Information

NPI Number	:	1841015948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUEL ANTONIO GARCIA

Provider Business Mailing Address
First Line	:	4706 49TH ST APT 2C
Second Line	:
City	:	WOODSIDE
State	:	NY
Zip	:	11377-6723
Country	:	US
Telephone Number	:	917-589-3755
Fax Number	:

Provider Business Practice Location Address
First Line	:	2103 31ST AVE
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-4521
Country	:	US
Telephone Number	:	646-875-8348
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2024
Last Update Date	:	12/02/2024

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